How to prevent glucose spikes between meals – Type 1 diabetes

How to prevent glucose spikes between meals – Type 1 diabetes

November 4, 2019 0 By Jose Scott


Hey everyone Mark Green here from
diabetesdietguy.com and markgreenutrition.co.uk which is my services page where I
offer dietary and nutrition advice for patients with diabetes, looking to lose
weight and generally live a healthier life. Now I must apologise because I feel
like I’ve been neglecting our type 1’s out there. A lot of my videos have been
pretty type 2 heavy of late so I thought I’d do a video on something I’ve
been seeing quite frequently in clinic also corresponding with patients over
email about. That is post meal glucose spikes this has been a problem
because historically when people would test on only their finger from a blood
glucose test we would generally see the pre meal result and the pre meal result
at the next meal. So we see like a 4 or 5 hour gap and as far as they were
concerned everything was okay but since then we see more technology be
introduced into the market such as the free style Libre and Dexcom which is
continuous glucose monitoring devices so actually now we’re trying to get a much
better idea of what glucose levels are doing between meals. I’m finding with a
lot of patients is there are post meal glucose spikes which previously we have
only been detected had they done a one hour or a two hour post new glucose test
which then really starts to rack up the number of tests they would have done
keeping in mind that a glucose or a fingerprint test is still only one point
in time, whereas with these continuous glucose monitoring devices, we can see
the whole trend between meals and overnight. So again how much broader
picture of what the glucose response is doing. I mean working with some of my
patients to try and find ways how to prevent these fights in between meals
and generally speaking we’ve come up with three or four ways that have been
pretty successful. They’re not evidence-based,
but actually from what we happening clinics and the data that I’m seeing
there’s been some useful strategies we’ve been able to implement. So I just
wanted to share some tips with you and see actually if it could help you out is
this is something that you’re seeing yourselves. In order to do this and
highlight what I’m talking about we need to get digital, so let’s get into the Mac.
Okay so I’ve drawn this out for you. The black line that is to come will
represent food. The blue line will represent insulin.
On the lefthand we have your glucose level / insulin response and at the bottom here we
have meal. So that’s when you’re gonna eat and then we have another label
that’s four to five hours later or your next meal.
Now the reason we’ve got the label four to five hours later is because that’s
how long you rapid insulin typically glucose levels spiking despite the fact that by the
time we’ve tested at next meal they come back to roughly where they started so we
can’t increase the incidence if we increase it they’re gonna hypo at that
four to five hour period later. So increasing the insulin won’t work. It is a timing issue so there’s a few things we
can play around with so as we can see this block right here that’s where the
damage is being done this is where we see in those post meal spikes now the
first thing we can do to adjust for this is move the insulin and this is because
your rapid-acting insulin takes about 30 minutes to get going and then you won’t
see the peak of its action until about an hour after you’ve injected so it’s
always playing catch-up with food unless you move the injection So we’re offsets the spike because it’s
able to keep it under control. Now this is probably textbook gold standard what
we’d like to do and if you’ve read a manual on diabetes and rapid-acting
insulin it always say inject 30 minutes before. So this is great advice but it’s
not always the most practical advice. So I’d recommend only doing this at meals
that you know you’re gonna eat so breakfast is usually a prime example
because typically you’re gonna sit down you eat it whereas when you’re at work
or you’re out and about you might inject thirty minutes before and then get
called away and then we set yourself up for disaster and probably a pretty big –
so we don’t want to do that. The reason that breakfast tends to be a good time
to do this it’s because breakfast tends to be one of those times that we have
quite quickly releasing carbohydrate so things like cereals
regardless of what type once you add the milk into the equation it softens it up
which makes it quite quick releasing it might be toast which can be white bread
or we had things like Jam and marmalades to it in which case it becomes very
quick releasing and so it makes it very hard for the rapid insulin that you
inject to keep up. So that’s the first thing we can do we can move the
injection. The second thing we can do in case you haven’t already guessed is we
can change the type of food that you having. So rather than having quick
releasing carbohydrates we can go to more slowly release carbohydrates so
rather than having things like white bread white pasta, white rice, cereals as
I mentioned, mashed potato, juice or sugary foods we can move to whole grain,
seeded oats, overnight oat, whole potatoes, new potatoes, beans, pulses,
lentils and vegetables, this is a much more favourable response and if we plot it on
the graph that looks a bit like this. You can see the food
is getting into the system much slower without moving the injection. This is another thing that I found with patients has actually
worked pretty well. I hope that makes sense and I find actually during our
helps to sort of display the message that I’m trying to get across without
just talking about it I think it’s much clearer when we can actually plot it out
like that. So ultimately it comes down to a couple of different things is the timing of insulin we can also
change the type of carbohydrate we’re having more slowly releasing one so as
opposed to more quickly releasing ones which can then be the difference between
a spike and not a spike but other things you can do the help so you might add in
some protein and fat into the meal because protein and fat actually slows
down the absorption of carbohydrates because the body has a lot more to
contend with as the break up the protein that has the break up the fat as well as
the carbohydrate so it’s got a lot more to do we tend to be more favorable in
terms of the glucose response okay. So the prime example of that would be
rather than having just toast you eggs with your toast and we’ve got
protein and fat on top of the carbohydrates
better glucose response. Then if you actually move the insulin a little bit
earlier as well you might just hit jackpot. The other thing that I’ve been
finding does work to some degree but there isn’t much evidence to support it
in the literature is reducing the total carbohydrate intake of meals. In term of these post mills spikes I have
found that just by lowering the amount of carbs going in has been quite
favorable for a lot of patients and I suspect there’s a few reasons for this.
The first is if they under dose themselves or they miscalculate their
insulin. then there’s less carbohydrate going in to potentially cause spikes. So we have less
potential for a spike. The other thing might be that because they are paying more
attention to their diet actually what they’ve done is calculated their
carbohydrates more closely and so they rapidinsulin dose matches their
carbohydrate intake more closely. The other thing it might be is actually just
these lower carbohydrate intakes just improves outcomes generally speaking in
terms of those post meal spikes but the evidence just hasn’t been there to show
it in the mass literature. So whatever the reason it is just something that
I’ve found has help some patients. So hopefully if you’ve been struggling with
this this is just a few ideas to play around with like I said no guarantee
it’s gonna work but these are just some strategies I’ve been putting into place
with my patients and we’ve been having success with it. So I’d love to hear how
you have been getting on with it, try out some of these strategies to see how you get on and
let me know if it’s worked because ultimately the more data and the more tips
I can get, because I don’t know everything about this you know you guys
in the experts are the ones living with it day in day out so you tell me and
I’ll take it on board and tell other patients about things that are working
for you too. I think we call it a day there so just make sure to remember to
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